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Mehta D, Thomas V, Johnson J, Scott B, Cortina S, Berger L. Continuation of Buprenorphine to Facilitate Postoperative Pain Management for Patients on Buprenorphine Opioid Agonist Therapy. Pain Physician 2020; 23:E163-E174. [PMID: 32214293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acute pain management in patients on buprenorphine opioid agonist therapy (BOAT) can be challenging. It is unclear whether BOAT should be continued or interrupted for optimization of postoperative pain control. OBJECTIVES To determine an evidence-based approach for pain management in patients on BOAT in the perioperative setting, particularly whether BOAT should be continued or interrupted with or without bridging to another mu opioid agonist and to identify benefits and harms of either perioperative strategy. STUDY DESIGN Systematic literature review with qualitative data synthesis. SETTING Hospital, perioperative. METHODS The study protocol was registered on PROSPERO (Registration number 9030276355). Medline via OVID, EMBASE, CINAHL, and the Cochrane CENTRAL register of trials were searched for prospective or retrospective observational or controlled studies, case series, and case reports that described perioperative or acute pain care for patients on BOAT. References of narrative and systematic reviews addressing acute pain management in patients on BOAT and references of included articles were hand-searched to identify additional original articles for inclusion. The full text of publications were reviewed for final inclusion, and data were extracted using a standardized data extraction form. Results were summarized qualitatively. Primary outcomes were postoperative pain intensity and total opioid use and identification of benefits and harms of perioperative strategies. RESULTS Eighteen publications presenting data on the perioperative management of patients on BOAT were identified: 10 case reports, 5 case series, and 3 retrospective cohort studies. Eleven articles reported continuation of BOAT, 2 concerned bridging BOAT, and 4 articles described stopping BOAT without planned bridging. In one retrospective cohort study, BOAT was continued in half and interrupted in half of patients. Patients on BOAT may have pain that is more difficult to treat than those who are not on OAT. There is no clear evidence that one particular strategy provides superior postoperative pain control, but interruption of BOAT may result in harm, including failure to return to baseline BOAT doses, continuing non-BOAT opioid use, or relapse of opioid use disorder. LIMITATIONS There were a limited number of articles relevant to the study question consisting of case reports and retrospective observational studies. Some omitted relevant details. No prospective studies were found. CONCLUSIONS There is no clear benefit to bridging or stopping BOAT but failure to restart it may pose concerns for relapse. We recommend continuing BOAT in the perioperative period when possible and incorporating an interdisciplinary approach with multimodal analgesia. KEY WORDS Opioid use disorder, opiate substitution treatment, buprenorphine, buprenorphine-naloxone, buprenorphine opioid agonist therapy, postoperative pain, acute pain, multimodal analgesia.
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Affiliation(s)
- Disha Mehta
- Department of Anesthesia, Surrey Memorial Hospital, Surrey, BC Canada
| | - Vinod Thomas
- Division of Pharmacy, Southern Adelaide Local Health Network, SA Pharmacy, SA Health, Adelaide, Australia
| | - Jacinta Johnson
- Division of Pharmacy, Southern Central Adelaide Local Health Network, SA Pharmacy, SA Health, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Brooke Scott
- Library Services, Fraser Health, Maple Ridge, BC Canada
| | - Sandra Cortina
- Department of Internal Medicine, St. Paul's Hospital, Vancouver, BC Canada
| | - Landon Berger
- Department of Anesthesiology and Pain Medicine, University of Alberta, Addiction Recovery and Community Health, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Cortina S, Kennedy MC, Dong H, Fairbairn N, Hayashi K, Milloy MJ, Kerr T. Willingness to use an in-hospital supervised inhalation room among people who smoke crack cocaine in Vancouver, Canada. Drug Alcohol Rev 2018; 37:645-652. [PMID: 29873125 DOI: 10.1111/dar.12815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 03/17/2018] [Accepted: 04/15/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND AIMS People who use illicit drugs (PWUD) often engage in drug use during hospitalisation. Adverse outcomes may arise from efforts to conceal inpatient drug use, especially in hospital settings that rely on abstinence-based policies. Harm reduction interventions, including supervised drug consumption services, have not been well studied in hospital settings. This study examines factors associated with willingness to use an in-hospital supervised inhalation room (SIR) among people who smoke crack cocaine in Vancouver, Canada. DESIGN AND METHODS Cross-sectional data from two open prospective cohorts of PWUD involving people who smoke crack cocaine were collected between June 2013 and May 2014. Multivariable logistic regression analyses were used to identify factors associated with willingness to use an in-hospital SIR. RESULTS Among 539 participants, 320 (59.4%) reported willingness to use an in-hospital SIR. Independent factors positively associated with willingness included: ever used drugs in hospital [adjusted odds ratio (AOR) = 1.89], and daily non-injection crack use (AOR = 1.63). Difficulty accessing new crack pipes (AOR = 0.51) was negatively associated with willingness (all P < 0.05). The most commonly reported reasons for willingness were to: remain in hospital (50.6%), reduce drug-related risks (25.6%) and reduce the stress of hospital discharge for using drugs (24.7%). DISCUSSION AND CONCLUSIONS A high proportion of people who smoke crack cocaine reported willingness to use an in-hospital SIR, and those willing were more likely to report heavy drug use and previous in-hospital use. These findings highlight the potential utility of SIRs to complement existing in-hospital services for PWUD.
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Affiliation(s)
- Sandra Cortina
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - M-J Milloy
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - Thomas Kerr
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
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Bramoullé C, Cortina S, Boulé T, Damany G, Husson F. 13. Assessing long-term stability of Electronic Portal Image Device-based dosimetry. Phys Med 2017. [DOI: 10.1016/j.ejmp.2017.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Affiliation(s)
- Raistlin Alexander Majere
- Internal Medicine (Majere), University of British Columbia, Vancouver, BC; University of Calgary (Cortina), Calgary, Alta.
| | - Sandra Cortina
- Internal Medicine (Majere), University of British Columbia, Vancouver, BC; University of Calgary (Cortina), Calgary, Alta
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Drotar D, Cortina S, Crosby LE, Hommel KA, Modi AC, Pai ALH. Competency-based postdoctoral research training for clinical psychologists: An example and implications. Training and Education in Professional Psychology 2015. [DOI: 10.1037/tep0000032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Psoriasis is a relatively common chronic inflammatory skin disease in children for which there is no cure. Most children have mild disease that can be managed with topical therapy as opposed to phototherapy or systemic therapy. Despite the mild presentation of psoriasis in most children, the disease can have a significant impact on quality of life due to the need for ongoing treatment, the frequently visible nature of the cutaneous manifestations, and the social stigma that is associated with psoriasis. Adherence to treatment, in particular topical therapy, is often poor in adults and compromises response to therapy and medical provider management strategies. Multiple factors that may contribute to nonadherence in adults with psoriasis have been identified, including lack of education on the disease and expectations for management, issues related to ease of use and acceptability of topical medications, and anxiety regarding possible medication side effects. There is currently no published data on adherence in the pediatric psoriasis population; however, poor adherence is often suspected when patients fail to respond to appropriate therapy. General strategies used to assess adherence in other pediatric disease populations can be applied to children with psoriasis, and interventions that reflect experience in other chronic dermatologic disorders such as atopic dermatitis may also be helpful for medical providers caring for children with psoriasis.
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Affiliation(s)
| | - Sandra Cortina
- Division of Behavioral Medicine and Clinical Psychology.,Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Wu YP, McGrady ME, Guilfoyle S, Slater S, Cortina S, Kocoshis S. Small bowel and multivisceral transplantation: Psychosocial needs and pediatric psychology interventions. Clinical Practice in Pediatric Psychology 2014. [DOI: 10.1037/cpp0000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Drotar D, Cortina S, Rohan JM, Somers M, Hilliard ME, Maddux M. Conducting psychological intervention research in pediatric clinical settings: Strategies and implications. Clinical Practice in Pediatric Psychology 2014. [DOI: 10.1037/cpp0000054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cortina S, Somers M, Rohan JM, Drotar D. Clinical Effectiveness of Comprehensive Psychological Intervention for Nonadherence to Medical Treatment: A Case Series. J Pediatr Psychol 2013; 38:649-63. [DOI: 10.1093/jpepsy/jss175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Herzer M, Ramey C, Rohan J, Cortina S. Incorporating electronic monitoring feedback into clinical care: a novel and promising adherence promotion approach. Clin Child Psychol Psychiatry 2012; 17:505-18. [PMID: 21949048 DOI: 10.1177/1359104511421103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents case examples that document the preliminary clinical utility of using electronic monitoring (EM) feedback to tailor empirically validated adherence-promoting interventions, delivered in standard clinical practice. Challenges of utilizing EM in standard clinical practice as well as future directions are also discussed. Two adolescents referred for behavioral adherence promotion intervention are described. Each youth was provided a MEMS® bottle and one oral medication was chosen jointly by the therapist, family, and medical provider for adherence monitoring. Graphical MEMS® feedback was provided to families during intervention visits and subsequently used to tailor adherence interventions to target each family's unique needs. EM feedback was a feasible and clinically rich supplement to adherence-promoting interventions. EM facilitated identification of adherence barriers and successes, and open and non-adversarial discussions regarding adherence between patients, families, and clinicians, and provided real-time representations of patients' medication administration. These case presentations suggest that EM feedback can be a clinically useful tool when used as a supplement to an empirically supported intervention delivered in standard psychological practice aimed at adherence promotion among chronically ill youth.
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Modi AC, Pai AL, Hommel KA, Hood KK, Cortina S, Hilliard ME, Guilfoyle SM, Gray WN, Drotar D. Pediatric self-management: a framework for research, practice, and policy. Pediatrics 2012; 129:e473-85. [PMID: 22218838 PMCID: PMC9923567 DOI: 10.1542/peds.2011-1635] [Citation(s) in RCA: 334] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Self-management of chronic pediatric conditions is a formidable challenge for patients, families, and clinicians, with research demonstrating a high prevalence of poor self-management and nonadherence across pediatric conditions. Nevertheless, effective self-management is necessary to maximize treatment efficacy and clinical outcomes and to reduce unnecessary health care utilization and costs. However, this complex behavior is poorly understood as a result of insufficient definitions, reliance on condition-specific and/or adult models of self-management, failure to consider the multitude of factors that influence patient self-management behavior, and lack of synthesis of research, clinical practice, and policy implications. To address this need, we present a comprehensive conceptual model of pediatric self-management that articulates the individual, family, community, and health care system level influences that impact self-management behavior through cognitive, emotional, and social processes. This model further describes the relationship among self-management, adherence, and outcomes at both the patient and system level. Implications for research, clinical practice, and health care policy concerning pediatric chronic care are emphasized with a particular focus on modifiable influences, evidence-based targets for intervention, and the role of clinicians in the provision of self-management support. We anticipate that this unified conceptual approach will equip stakeholders in pediatric health care to (1) develop evidence-based interventions to improve self-management, (2) design programs aimed at preventing the development of poor self-management behaviors, and (3) inform health care policy that will ultimately improve the health and psychosocial outcomes of children with chronic conditions.
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Affiliation(s)
- Avani C. Modi
- Address correspondence to Avani C. Modi, PhD, Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self-Management, MLC-7039, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail:
| | - Ahna L. Pai
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kevin A. Hommel
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Korey K. Hood
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Sandra Cortina
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Marisa E. Hilliard
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Shanna M. Guilfoyle
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Wendy N. Gray
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Ting TV, Kudalkar D, Nelson S, Cortina S, Pendl J, Budhani S, Neville J, Taylor J, Huggins J, Drotar D, Brunner HI. Usefulness of cellular text messaging for improving adherence among adolescents and young adults with systemic lupus erythematosus. J Rheumatol 2011; 39:174-9. [PMID: 22089460 DOI: 10.3899/jrheum.110771] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In a cohort of 70 patients with childhood-onset systemic lupus erythematosus (cSLE): to determine the baseline adherence to medications and visits; to investigate the effects of cellular text messaging reminders (CTMR) on adherence to clinic visits; and to study the influence of CTMR on adherence to use of hydroxychloroquine (HCQ). METHODS CTMR were sent to 70 patients prior to clinic visits for 14 months. A subgroup of patients were evaluated for medication adherence to HCQ: 19 patients receiving CTMR prior to each scheduled HCQ dose were compared to 22 patients randomized to standard of care education about HCQ. Visit adherence was measured using administrative databases. Pharmacy refill information, self-report of adherence, and HCQ blood levels were utilized to monitor medication adherence to HCQ. Sufficient adherence to visits or HCQ was defined as estimates > 80%. Disease activity was primarily monitored with the Systemic Lupus Erythematosus Disease Activity Index. RESULTS At baseline, 32% of patients were sufficiently adherent to HCQ, and 81% to clinic visits. Visit adherence improved significantly by > 80% among those who were nonadherent to clinic visits at the baseline CTMR (p = 0.01). CTMR did not influence adherence to HCQ over time. CONCLUSION Patients with cSLE were only modestly adherent to HCQ and clinic visits. CTMR may be effective for improving visit adherence among adolescents and young adults with cSLE, but it does not improve adherence to HCQ.
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Affiliation(s)
- Tracy V Ting
- Cincinnati Children's Hospital Medical Center, William Rowe Division of Rheumatology, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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Hilliard ME, Ramey C, Rohan JM, Drotar D, Cortina S. Electronic monitoring feedback to promote adherence in an adolescent with Fanconi Anemia. Health Psychol 2011; 30:503-9. [PMID: 21688912 DOI: 10.1037/a0024020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This report describes an intervention to promote medication adherence and treat comorbid psychological symptoms in a 17 year-old female with Fanconi Anemia. The patient presented with a typical adherence rate estimated at 25% and self-reported symptoms of depressed mood and anxiety. METHOD Our comprehensive treatment approach integrated electronic monitoring (EM), an emerging strategy for adherence promotion, and motivational interviewing (MI) within an evidence-based cognitive-behavioral therapy (CBT) framework. We used EM data to assess and track medication adherence. The therapist reviewed these data with the patient and family in session and used MI techniques to promote health behavior change. We analyzed changes in adherence rates over time using a time series analysis (Auto-Regressive Moving Average [ARIMA]). In addition, the patient and her mother reported on depression, anxiety, and quality of life at intake and after 12 months, and the therapist treated psychological symptoms with CBT. RESULTS The average adherence rate during the baseline EM phase was ~53%. The mean adherence rate across treatment was ~77%, and after 17 months, the final weekly adherence rate was 82%. Adherence rates significantly improved over the treatment period, ARIMA t = 36.16, p < .01. CONCLUSIONS EM feedback and MI are viable additions to CBT to promote medication adherence in adolescence. This approach has the potential to effectively treat adolescents with adherence problems and psychological symptoms across multiple chronic illness diagnoses, and ultimately to improve health and quality of life outcomes.
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Affiliation(s)
- Marisa E Hilliard
- Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Hilliard ME, Ernst MM, Gray WN, Saeed SA, Cortina S. Adapting pediatric psychology interventions: lessons learned in treating families from the Middle East. J Pediatr Psychol 2011; 37:882-92. [PMID: 21990584 DOI: 10.1093/jpepsy/jsr084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Pediatric psychologists are increasingly called upon to treat children from non-Western countries, whose cultures may contrast with a Western medical setting. Research on cultural adaptations of evidence-based treatments (EBTs), particularly for individuals from the Middle East, is sparse. To address this need, we discuss clinical issues encountered when working with patients from the Middle East. METHODS Synthesis of the literature regarding culturally adapted EBTs and common themes in Middle Eastern culture. Case vignettes illustrate possible EBT adaptations. RESULTS Integrating cultural values in treatment is an opportunity to join with patients and families to optimize care. Expectations for medical and psychological treatment vary, and collaborations with cultural liaisons are beneficial. CONCLUSIONS Critical next steps include systematic development, testing, and training in culturally adapting EBTs in pediatric medical settings. Increased dialogue between clinicians, researchers, and cultural liaisons is needed to share knowledge and experiences to enhance patient care.
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Affiliation(s)
- Marisa E Hilliard
- Center for Treatment Adherence, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7039, Cincinnati, OH 45229, USA.
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Cortina S, McGraw K, Dealarcon A, Ahrens A, Rothenberg ME, Drotar D. Psychological Functioning of Children and Adolescents With Eosinophil-Associated Gastrointestinal Disorders. Child Health Care 2010; 39:266-278. [PMID: 21532963 DOI: 10.1080/02739615.2010.515927] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study examined health-related quality of life and adjustment among children with eosinophil- associated gastrointestinal disorders (EGID) compared with an age-matched sample without acute or chronic illness. Participants were youth ages 2 to 18 years. Children and caregivers completed measures of psychological symptoms and health-related quality of life (HRQOL). Significant group differences were found for child report of depressive, as well as anxiety symptoms. Significant group differences were also found for caregiver report of psychological symptoms and social skills. Finally, based on parent and youth report, HRQOL and greater school absenteeism were associated with EGID diagnosis.
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Affiliation(s)
- Sandra Cortina
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Cortina S, Repaske DR, Hood KK. Sociodemographic and psychosocial factors associated with continuous subcutaneous insulin infusion in adolescents with type 1 diabetes. Pediatr Diabetes 2010; 11:337-44. [PMID: 19761529 DOI: 10.1111/j.1399-5448.2009.00593.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the role of sociodemographic factors and psychosocial adjustment in continuous subcutaneous insulin infusion (CSII) use among adolescents with type 1 diabetes. METHODS A total of 150 adolescents with type 1 diabetes and their caregivers completed measures of general psychological functioning, diabetes functioning, and stressful life events. Blood glucose monitoring (BGM) frequency and glycemic control were also assessed. Logistic regression was used to determine associations between CSII use and sociodemograpic and psychosocial factors. RESULTS All logistic regression models were significant, indicating a large proportion of the variance in CSII use was associated with sociodemographic, diabetes-specific and psychosocial variables. Final models showed higher frequency of BGM and having private insurance as significant correlates of CSII use. CSII use was also associated with adolescent and caregiver reports of sharing of responsibilities around diabetes management and negative affect regarding BGM. CONCLUSIONS Adolescents currently prescribed CSII therapy evidenced key differences from their counterparts using multiple daily injections (MDI) in insurance status, diabetes management behavior, and family functioning related to diabetes. Efforts to understand the role of family factors in the maintenance of CSII therapy with clinical indicators of CSII use may inform treatment effectiveness.
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Affiliation(s)
- Sandra Cortina
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Corella D, Guillén M, Sáiz C, Portolés O, Sabater A, Cortina S, Folch J, González JI, Ordovas JM. Environmental factors modulate the effect of the APOE genetic polymorphism on plasma lipid concentrations: ecogenetic studies in a Mediterranean Spanish population. Metabolism 2001; 50:936-44. [PMID: 11474482 DOI: 10.1053/meta.2001.24867] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To investigate APOE gene--environment interaction effects on plasma lipid concentrations, we conducted a cross-sectional study in a Mediterranean Spanish population consisting of 396 men and 513 women aged 18 to 66 years. The frequency of the epsilon 4 variant was 0.071 (95% confidence interval 0.059, 0.082), confirming the lower frequency of this allele in Southern Europe. In general, the carriers of the epsilon 2 variant had lower concentrations (P <.05) of total and low-density lipoprotein cholesterol (LDL-C), carriers of the epsilon 3 variant had intermediate concentrations, and carriers of the epsilon 4 variant had higher concentrations (P <.05) in both sexes, even after multivariate adjustment for age, body mass index, alcohol consumption, tobacco smoking, physical activity, marital status, and education. However, when the homogeneity of allelic effects according to environmental factors was tested, significant interaction terms were found. In women, an important interaction between alcohol consumption and the APOE polymorphism in determining LDL-C concentrations was found (P <.003). LDL-C concentrations in female drinkers with the epsilon 2 variant were significantly lower (P <.014) than in nondrinkers with the epsilon 2 variant. Likewise, in female drinkers with the epsilon 4 variant, LDL-C concentrations were also significantly (P <.010) lower than in nondrinkers with the epsilon 4 variant. Moreover, in female drinkers, LDL-C concentrations did not differ between carriers of the epsilon 4 and the epsilon 3 variants, and in nondrinkers, LDL-C concentrations did not differ between carriers of the epsilon 2 and the epsilon 3 variants. We also found a statistically significant interaction effect (P <.001) between the APOE polymorphism and physical activity in determining high-density lipoprotein cholesterol concentrations in men. Our results indicate that environmental factors are important modulators of the effect of the APOE polymorphism on plasma lipid concentrations.
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Affiliation(s)
- D Corella
- Genetic and Molecular Epidemiology Unit, Department of Preventive Medicine and Public Health, Universitat de València, Valencia, Spain
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Corella D, Guillén M, Portolés O, Sabater A, Cortina S, Folch J, Sáiz C. [Apolipoprotein E gene polymorphism and risk of hypercholesterolemia: a case control study in a working population of Valencia]. Med Clin (Barc) 2000; 115:170-5. [PMID: 10996872 DOI: 10.1016/s0025-7753(00)71498-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The apolipoprotein E (apoE) gene is polymorphic with three common alleles (epsilon 2, epsilon 3, epsilon 4) whose allelic frequency and association with lipid levels varies from population to population. The aim of this study was to estimate the association between these genetic variants and the risk of hypercholesterolemia in a Mediterranean Spanish population. PATIENTS AND METHODS A case-control study in a working population from Valencia was carried out. A total of 330 cases (148 men and 182 women) with moderate hypercholesterolemia (total cholesterol > 200 mg/dl or with lipid lowering treatment) and age range 20 to 60 years, were identified. 330 normocholesterolemic controls matched by age and sex were selected. From all of them data of apoE genotype, body mass index, lipid and lipoprotein levels, socioeconomic and life-style variables were obtained. RESULTS The epsilon 2 allele frequency was statistically lower in cases (0.033) than in controls (0.086). The epsilon 4 allele frequency was higher in cases (0.115) than in controls (0.039). In the crude logistic regression analysis, the apoE polymorphism was related (p < 0.001) to the risk of hypercholesterolemia. After adjustment by age, body mass index, educational level, tobacco smoking, alcohol consumption and physical activity the epsilon 2 allele was associated with a lower risk of hypercholesterolemia (odds ratio [OR] = 0.36; 95% confidence interval (CI): 0.20-0.64), and the epsilon 4 allele was associated with a higher risk (OR = 3.04; 95% CI: 1.82-5.06). CONCLUSIONS The apoE genotype was significantly related to the risk of moderate hypercholesterolemia in the Mediterranean Spanish population.
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Affiliation(s)
- D Corella
- Departamento de Medicina Preventiva y Salud Pública, Universitat de València.
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